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Sex, Risk and Responsibility: Provider Attitudes and Beliefs Predict HIV Transmission Risk Prevention Counseling in Clinical Care Settings

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Abstract

We examined factors associated with the frequency of HIV “prevention with positives” (PwP) counseling delivered by providers participating in demonstration projects at 26 clinics. Three hundred and fifteen primary care and support service providers completed a survey assessing the frequency of PwP delivered at initial medical care visits and at regular care visits. Providers reported delivering PwP counseling to more patients at initial visits (67%) than to those returning for regular care (53%; t = 11.8, p < 0.001). During initial and regular care visits, providers reporting a sense of responsibility for conducting PwP and those regularly discussing the risk of reinfection with patients reported significantly more frequent PwP counseling. Providers expressing a belief that no matter how much counseling was delivered, some HIV-infected patients would still infect others (prevention fatalism) reported significantly less frequent counseling at all visits. To improve the quality and quantity of HIV PwP counseling, providers training should address attitudinal barriers and facilitators to counseling and the importance of addressing risk routinely.

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References

  • Erbelding, E. J., Stanton, D., Quinn, T. C., & Rompalo, A. (2000). Behavioral and biologic evidence of persistent high-risk behavior in an HIV primary care population. Aids, 14(3), 297–301.

    Article  PubMed  CAS  Google Scholar 

  • Centers for Disease Control, Prevention (CDC), Health Resources and Services Administration, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of America. (2003). Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recommendations and Reports, 52(RR-12), 1–24.

    Google Scholar 

  • Fisher, J. D., Fisher, W. A., Cornman, D. H., Amico, R. K., Bryan, A., & Friedland, G. H. (2006). Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. Journal of Acquired Immune Deficiency Syndromes, 41(1), 44–52.

    Article  PubMed  Google Scholar 

  • Gerbert, B., Brown, B., Volberding, P., Cooke, M., Caspers, N., Love, C., et al. (1999). Physicians’ transmission prevention assessment and counseling practices with their HIV positive patients. Aids Education and Prevention, 11(4), 307–320.

    PubMed  CAS  Google Scholar 

  • Gerbert, B., Love, C., Caspers, N., Linkins, K., & Burack, J. (1999). “Making all the difference in the world”: How physicians can help HIV-seropositive patients become more involved in their healthcare. AIDS Patient Care and STDs, 13(1), 29–39.

    Article  PubMed  CAS  Google Scholar 

  • Grant, R., et al. (2006). Serosorting and strategic positioning fact sheet from the positive partners study. Published on-line by the Positive Partners study, University of California, San Francisco (http://www.gladstone.ucsf.edu/gladstone/files/pospart/Serosorting%20and%20superinfection%20handout.pdf). Accessed March 3, 2007.

  • Grassia, T. (2004). Superinfection among couples with HIV questioned: Study finds no evidence of superinfection, suggests physicians continue promoting serosorting. Infectious Disease News. August issue, published online (http://www.infectiousdiseasenews.com/200408/frameset.asp? article=superinfection.asp). Accessed March 3, 2007.

  • Institute of Medicine. (2001). No time to lose: Getting more from HIV prevention. Washington, DC: National Academy of Sciences.

    Google Scholar 

  • Mayer, K. H., Safren, S. A., & Gordon, C. M. (2004). HIV care providers and prevention: Opportunities and challenges. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl. 2), S130–S132.

    PubMed  Google Scholar 

  • Metsch, L. R., Pereyra, M., del Rio, C., et al. (2004) Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities. American Journal of Public Health, 94, 1186–1192.

    Article  PubMed  Google Scholar 

  • Morin, S. F., Koester, K. A., Steward, W. T., Maiorana, A., McLaughlin, M., Myers, J. J., et al. (2004). Missed opportunities: Prevention with HIV-infected patients in clinical care settings. Journal of Acquired Immune Deficiency Syndromes, 36(4), 960–966.

    Article  PubMed  Google Scholar 

  • Myers, J. J., Malitz, F. E., Koester, K., Maiorana, A., Dawson Rose, C., Eldred, L., et al. (2006). HIV physician practices and attitudes towards risk assessment and counseling in the US Health Resources and Services Administration’s (HRSA) HIV prevention with HIV-infected individuals seen in clinical settings initiative. Paper presented at the XVI International AIDS Conference, Toronto.

  • Myers, J. J., Steward, W. T., Charlebois, E., Koester, K. A., Maiorana, A., & Morin, S. F. (2004). Written clinic procedures enhance delivery of HIV “Prevention With Positives” counseling in primary health care settings. Journal of Acquired Immune Deficiency Syndromes, 37(Suppl. 2), S95–S100.

    PubMed  Google Scholar 

  • Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J., et al. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: A multi-clinic assessment. Aids, 18(8), 1179–1186.

    Article  PubMed  Google Scholar 

  • Steward, W. T., Koester, K. A., Myers, J. J., & Morin, S. F. (2006). Provider fatalism reduces the likelihood of HIV-prevention counseling in primary care settings. AIDS and Behavior, 10(1), 3–12.

    Article  PubMed  Google Scholar 

  • Wilson, I. B., & Kaplan, S. (2000) Physician-patient communication in HIV disease: The importance of patient, physician, and visit characteristics. Journal of Acquired Immune Deficiency Syndrome, 25, 417–425.

    Article  CAS  Google Scholar 

  • Zuniga, J. M. (2006). State of HIV treatment: Results of the International Association of Physicians in AIDS care surveys of HIV-positive patients and HIV-treating physicians in the United States. Journal of the International Association of Physicians in AIDS Care, 5(2), 51–56.

    Article  PubMed  Google Scholar 

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Acknowledgments

This publication is supported by grant number 5 H97 HA00261 from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of HRSA or the SPNS program.

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Correspondence to Janet J. Myers.

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Myers, J.J., Rose, C.D., Shade, S.B. et al. Sex, Risk and Responsibility: Provider Attitudes and Beliefs Predict HIV Transmission Risk Prevention Counseling in Clinical Care Settings. AIDS Behav 11 (Suppl 1), 30–38 (2007). https://doi.org/10.1007/s10461-007-9269-9

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  • DOI: https://doi.org/10.1007/s10461-007-9269-9

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